Objective: To evaluate our outcomes after minimally invasive or thoraco-laparoscopic esophagectomy (TLE) with thoracoscopic mobilization of the esophagus and mediastinal esophagectomy in prone position. Methods: From January 1997 through April 2005, TLE was performed in 130 patients. All patients had histologically proven squamous cell carcinoma of middle third of the esophagus. Only 1 (0.77%) patient received neo-adjuvant chemotherapy. The thoracoscopic part of the procedure was performed in prone position with excellent ergonomics translating into less operative time and better respiratory results. We performed a minilaparotomy to retrieve the specimen owing to bulky tumors. Feeding jejunostomy and pyloromyotomy were performed in all patients.RESULTS: There were 102 males and 28 females. Median age was 67.5 years (range, 38-78). There was no conversion to open method. The median intensive care unit stay was 1 day (range, 1-32); hospital stay was 8 days (range, 4-68). The perioperative mortality was 1.54% (n=2). Anastomotic leak rate was 2.31% (n=3). There was no incidence of tracheal or lung injury; and no evidence of postoperative pneumonia. At the mean follow-up of 20 months (range, 2-70), stage specific survival was similar to open as well as other minimally invasive series.Conclusions: TLE with thoracoscopic part in prone position is technically feasible with low incidence of respiratory complications and requires less operative time. In our experience, we observed a lower mortality rate (1.54%), shorter hospital stay (8 days) and no incidence of postoperative pneumonia.